Sr. Risk & Quality Performance Manager (Remote)

Lensa; Saint Petersburg (FL); Remote; USD 77,000 - 172,000; Full time

Job summary

An established industry player is seeking a Sr. Risk & Quality Performance Manager to lead initiatives that enhance healthcare outcomes. This role involves collaborating with various teams to manage data analytics, ensuring program delivery aligns with strategic objectives. Candidates should have extensive experience in program management, risk adjustment, and quality metrics, with strong analytical and communication skills. If you are passionate about making a difference in healthcare and thrive in a collaborative environment, this opportunity is perfect for you.

Qualifications

• 4+ years in program/project management focused on risk adjustment and quality.
• Extensive healthcare experience with strong analytical and communication skills.

Responsibilities

• Lead projects to improve risk and quality outcomes through data analysis.
• Collaborate with stakeholders to manage program changes and ensure quality standards.

Skills

Program Management

Data Analysis

Stakeholder Collaboration

Healthcare Risk Adjustment

HEDIS Reporting

Microsoft Azure

SQL

Microsoft Office

Problem-Solving

Communication Skills

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Excel

Microsoft Project

SQL Server

Job description

Sr. Risk & Quality Performance Manager (Remote)

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Job Description

Job Summary

The Sr. Risk & Quality Performance Manager is a tactical execution role that will lead specific projects to support Molina’s Risk & Quality Solutions (RQS) team and program outcomes. This position collaborates with various departments and stakeholders within Molina to plan, coordinate, and manage resources and execute performance improvement initiatives in alignment with RQS’s strategic objectives.

Job Duties

• Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategy, analytics, and reporting, including risk/quality rate trending, provider measure performance, CAHPS and survey analytics, health equity, SDOH, and engaging external vendors.
• Ensure programs are delivered on time, within scope, and resources.
• Manage Risk/Quality data ingestion activities and strategies, including EHR/HIE optimization.
• Meet customer expectations, establish relationships, and gain trust and respect.
• Resolve complex problems through project management, data analytics, and stakeholder collaboration.
• Manage program changes, ensure alignment with goals, and update leadership.
• Draw actionable conclusions, make decisions, and collaborate with other teams.
• Ensure deliverables meet quality standards and regulatory requirements.
• Partner with teams to ensure data quality and identify opportunities to close care gaps.
• Identify risks and execute mitigation strategies.
• Proactively communicate risks and issues to stakeholders and leadership.
• Create, review, and approve program documentation, ensuring accessibility and updates.
• Provide regular status updates to stakeholders, highlighting progress, risks, and issues.
• Function as a team SME and support other requests as needed.

Job Qualifications

Required Education: Bachelor’s degree or equivalent experience.

Required Experience/Skills:

• 4+ years in program/project management in risk adjustment and/or quality.
• 4+ years supporting HEDIS engine activity, risk adjustment targeting, and reporting systems.
• 4+ years data analysis experience, utilizing technical skills to answer risk and quality questions.
• Experience with queries in Microsoft Azure or SQL Server.
• Mastery of Microsoft Office, including Excel and Project.
• Extensive healthcare experience with risk adjustment and/or quality knowledge.
• Strong partnering skills across organizational levels.
• Quantitative aptitude, problem-solving skills, and ability to communicate complex concepts clearly.
• Excellent verbal, written, and presentation skills.
• Energetic and collaborative attitude.

Preferred Education

Graduate degree or equivalent experience.

Preferred Experience

• Supporting leadership in cross-functional, matrixed organizations.
• SQL fluency.
• Knowledge of healthcare claim elements (CPT, LOINC, SNOMED, etc.).
• Success in roles impacting Risk Adjustment and HEDIS.

Preferred Certifications

PMP, Six Sigma Green/Black Belt, or similar coursework.

To apply, current Molina employees should use the intranet. Molina offers competitive benefits. EOE.

Pay Range: $77,969 - $171,058 annually.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job functions: Research, Analysis, IT
• Industries: IT Services, Consulting